Factors Influencing the Effectiveness of Adopting Electronic Medical Record-Based Reporting Systems for Notifiable Disease Surveillance: A Quantitative Analysis.

The coronavirus disease 2019 (COVID-19) pandemic has led to greater attention being given to infectious disease surveillance systems and their notification functionalities. Although numerous studies have explored the benefits of integrating functionalities with electronic medical record (EMR) systems, empirical studies on the topic are rare. The current study assessed which factors influence the effectiveness of EMR-based reporting systems (EMR-RSs) for notifiable disease surveillance. This study interviewed staff from hospitals with a coverage that represented 51.39% of the notifiable disease reporting volume in Taiwan. Exact logistic regression was employed to determine which factors influenced the effectiveness of Taiwan's EMR-RS. The results revealed that the influential factors included hospitals' early participation in the EMR-RS project, frequent consultation with the information technology (IT) provider of the Taiwan Centers for Disease Control (TWCDC), and retrieval of data from at least one internal database. They also revealed that using an EMR-RS resulted in more timely, accurate, and convenient reporting in hospitals. In addition, developing by an internal IT unit instead of outsourcing EMR-RS development led to more accurate and convenient reporting. Automatically loading the required data enhanced the convenience, and designing input fields that may be unavailable in current databases to enable physicians to add data to legacy databases also boosted effectiveness of the reporting system.

Determinants of nurses' willingness to receive vaccines: Application of the health belief model.

AIMS AND OBJECTIVES: To assess the willingness of nurses to receive vaccines as recommended by Taiwan's "Immunization Recommendations for Healthcare Personnel" (IRHCP), as well as the factors associated with their willingness. BACKGROUND: Immunisation for healthcare personnel (HCP) is a means of reducing pathogen transmission. Also, vaccinating HCP reduces personnel and labour costs during an epidemic. METHODS: A cross-sectional study was conducted. A self-administered questionnaire survey targeting nurses working in various service units at three hospitals was used. In total, 413 nurses completed the questionnaire. The main outcome measure was the willingness to receive vaccines recommended by the IRHCP, and the variables we assessed included knowledge regarding the IRHCP, individual perceptions (perceived risk of contracting the infection, perceived severity of the infection and perceived transmissibility after disease onset), perceived benefits and barriers to the vaccination, cues to the vaccination and demographics. This study followed the STROBE checklist for reporting this study. RESULTS: The willingness of nurses to receive vaccines recommended by the IRHCP was high; the highest level of willingness was for the hepatitis B vaccine. The nurses' willingness to receive various vaccines recommended by the IRHCP was predicted by the knowledge regarding the IRHCP and perceived transmissibility after disease onset. Except the diphtheria-tetanus-acellular pertussis vaccine, perceived benefits and perceived barriers were also predictors of the willingness to receive vaccines. CONCLUSIONS: Our results showed that interventions focusing on increasing the knowledge regarding the IRHCP and perceived transmissibility after disease onset, emphasising the benefits of the vaccination and reducing the perceived barriers to the vaccination are needed to increase nurses' willingness to receive vaccines. RELEVANCE TO CLINICAL PRACTICE: It is suggested using health education courses and mass media broadcasts at the individual and societal levels to raise awareness regarding the benefits of vaccines and enhance nurse' confidence in vaccination programs.

Evaluation of an adjustable epidemiologic information system.

BACKGROUND: In order to facilitate public health response and to achieve early control of infectious disease epidemics, an adjustable epidemiologic information system (AEIS) was established in the Taiwan public health network in February 2006. METHODOLOGY/PRINCIPAL FINDINGS: The performance of AEIS for the period 2006 through 2008 was evaluated based on a number of response times (RT) and the public health impact. After implementation of the system, the apparent overall shortened RT was mainly due to the shortening of personnel response time (PRT) and the time needed to draft a new questionnaire that incurred as personnel-system interface (PSI); PRT dropped from a fluctuating range of 9.8 ∼28.8 days in the first four months to <10 days in the following months and remained low till 2008 (0.88±1.52 days). The PSIs for newly emerged infectious diseases were 2.6 and 3.4 person-hours for H5N1 in 2007 and chikungunya in 2008, respectively, a much improvement from 1142.5 person-hours for SARS in 2003. The duration of each rubella epidemic cluster was evaluated as public health impact and showed a shortening trend (p = 0.019) that concurred with the shortening of PRT from 64.8±47.3 to 25.2±38.2 hours per cluster (p<0.0001). CONCLUSIONS/SIGNIFICANCE: The first evaluation of the novel instrument AEIS that had been used to assist Taiwan's multi-level government for infectious diseases control demonstrated that it was well integrated into the existing public health infrastructure. It provided flexible tools and computer algorithms with friendly interface for timely data collection, integration, and analysis; as a result, it shortened RTs, filled in gaps of personnel lacking sufficient experiences, created a more efficient flow of response, and identified asymptomatic/mild cases early to minimize further spreading. With further development, AEIS is anticipated to be useful in the application of other acute public health events needing immediate orchestrated data collection and public health actions.

Low seroprevalence of parvovirus B19 in Taiwanese children and young adults.

BACKGROUND: This study aimed to evaluate the prevalence of parvovirus B19 antibodies in children and young adults aged=30 years old in Taiwan. METHODS: Stored serum samples from healthy volunteers aged 1-29 years in Taipei were randomly selected and tested for antiparvovirus B19 immunoglobulin G by enzyme immunoassay. RESULTS: A total of 277 serum samples were tested. The overall seroprevalence of parvovirus B19 in Taiwanese children and young adults was 23.1% (64/277) in 2004. The positive rate increased slightly with age; it ranged from 15.0% in those aged 1-4 years to 30.8% in those aged 25-29 years (trend test, p=0.01). The age-adjusted anti-B19 immunoglobulin G seropositive rate was slightly higher in males (27.8%) than in females (18.8%; adjusted odds ratio: 0.56; 95% confidence interval: 0.32-0.99). CONCLUSION: Most children and young adults in Taipei City are not immune to parvovirus B19, suggesting that no parvovirus B19 epidemic has occurred in the last few decades.

Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan.

BACKGROUND: With international concern over emerging infectious diseases (EID) and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS) capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC) starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making. METHODS: Between June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005. RESULTS: Taiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p < 0.001). It also identified increases in the upper, lower, and total gastrointestinal (GI) syndrome groups starting in November 2004 and two clear spikes in enterovirus-like infections coinciding with the two school semesters. Using ED-SSS for surveillance of influenza-like illnesses and enteroviruses-related infections has improved Taiwan's pandemic flu preparedness and disease control capabilities. CONCLUSION: Taiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration.

Challenges faced by hospital healthcare workers in using a syndrome-based surveillance system during the 2003 outbreak of severe acute respiratory syndrome in Taiwan.

Because the severe acute respiratory syndrome (SARS) outbreak in Taiwan in 2003 was worsened by hospital infections, we analyzed 229 questionnaires (84.8% of 270 sent) completed by surveyed healthcare workers who cared for patients with SARS in 3 types of hospitals, to identify surveillance problems. Atypical clinical presentation was the most often reported problem, regardless of hospital type, which strongly indicates that more timely syndromic surveillance was needed.

Severe acute respiratory syndrome coronavirus on hospital surfaces.

BACKGROUND: Health care workers continued to contract severe acute respiratory syndrome (SARS), even after barrier precautions were widely implemented. METHODS: We explored the possible contribution of contaminated hospital surfaces to SARS transmission by swabbing surfaces in 2 hospitals and testing the swab samples by reverse-transcriptase polymerase chain reaction (RT-PCR) and viral culture. RESULTS: Twenty-six of 94 swab samples tested positive for viral RNA. Swab samples of respiratory secretions from each of the 4 patients examined tested positive by RT-PCR, as were 12 of 43 swabs from patient rooms and 10 of 47 swabs from other parts of the hospital, including the computer mouses at 2 nursing stations and the handrail of the public elevator. Specimens from areas with patients with SARS in the most infectious phase of illness (days 5-15 after onset) were more likely to be RNA positive than were swab specimens from elsewhere (24 of 63 samples vs. 2 of 31 samples; P=.001). All cultures showed no growth. CONCLUSIONS: Although the viruses identified may have been noninfectious, health care workers should be aware that SARS coronavirus can contaminate environmental surfaces in the hospital, and fomites should be considered to be a possible mode of transmission of SARS.

Control measures for severe acute respiratory syndrome (SARS) in Taiwan.

As of April 14, 2003, Taiwan had had 23 probable cases of severe acute respiratory syndrome (SARS), 19 of which were imported. Taiwan isolated all 23 patients in negative-pressure rooms; extensive personal protective equipment was used for healthcare workers and visitors. For the first 6 weeks of the SARS outbreak, recognized spread was limited to one healthcare worker and three household contacts.